This patient safety research demonstration project, conducted by the Center for Medical Injury Prevention at the Medical College of Wisconsin, will enhance and evaluate the Wisconsin Medical Injury Reporting System (WMIRS), an efficient and innovative approach to identifying patient injuries in hospitals. WMIRS identifies medical injuries in routinely collected hospital discharge data using validated criteria based on a comprehensive review of ICD-9 N-codes and E- codes. We will also evaluate the following strategies of disseminating information on medical injuries and reducing medical injuries in Wisconsin hospitals: - Benchmarking only. Administration, professional leadership, and risk management officials would receive information on the occurrence of medical injuries within their hospital and comparison of their hospital- specific injury rates to the average rate in all hospitals within the state. - Best practices-based interventions. This group would receive the benchmarking reports described above, as well as a set of interventions developed by identifying the best practices of hospitals with low rates of medical injury occurrence. - Evidence-based interventions. This group of hospitals would receive the benchmarking reports described above, as well as a set of interventions developed based on rigorous research studies such as controlled clinical trials. - Control group. A fourth group of hospitals within Wisconsin would serve as controls in which we would monitor the occurrence of medical injuries before, during and after the intervention but would provide no feedback to individual hospitals or any other intervention. To implement the interventions developed as a result of the best practices and evidence-based processes, we will utilize three of the standard approaches to modifying provider behavior. 1) guidelines and pathways; 2) opinion leaders; and 3) continuing medical education. The endorsement of the State Medical Society, the Wisconsin Hospital Association, and the Wisconsin of Public Health will facilitate this demonstration project.